Effects of Pressure-controlled Ventilation Targeting End-inspiratory Flow Rate on Pulmonary Complications and Inflammation Levels in Patients Undergoing Spinal Surgery in the Prone Position: a Randomized Clinical Trial

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2024 Feb 9

PMID 38336616

Authors

Na Wang

Yong Ye

Hui Lin

Tingting Sun

Yue Hu

Yuanhang Shu

Jing Tong

Yong Tao

Zeyu Zhao

Affiliations

Soon will be listed here.

Abstract

Background: This study assessed the impact of pressure-controlled ventilation (PCV) focusing on end-inspiratory flow rate on the incidence of postoperative pulmonary complications (PPCs) and inflammation levels in patients undergoing spinal surgery in the prone position.

Methods: A total of 187 patients who underwent posterior spinal surgery were enrolled and randomly divided into 3 groups: 61 in the volume-controlled ventilation (VCV) group (group V), 62 in the PCV-volume-guaranteed (VG) group (group P), and 64 in the PCV-VG end-expiratory zero flow rate group (group P). Indicators including tidal volume (V), peak airway pressure (P), and dynamic lung compliance (Cdyn) were recorded. The P, Cdyn, PCO2, and oxygenation index (PaO/FiO) after intubation (T), after prone position (T), 60 min after prone position (T), and after supine position at the end of surgery (T) of the three groups were collected.

Results: In the within-group comparison, compared with T, P increased at T in groups V and P (P < 0.01), whereas it decreased at T in group P (P < 0.01). Cdyn decreased at T and PaO2/FiO2 increased at T in all three groups (P < 0.01), and PaO2/FiO2 increased at T (P < 0.01). Compared with group V, P decreased at T in group P (P < 0.01) and at T in group P (P < 0.01), while Cdyn increased at T in groups P and P (P < 0.01). Compared with group P, P was elevated at T (P < 0.01) and decreased at T (P < 0.05), and Cdyn was elevated at T in group P (P < 0.01). The total incidence of PPCs in group P was lower than that in group V (P < 0.01). Compared with the preoperative period, serum interleukin 6 (IL-6) and C-reactive protein (CRP) levels were increased at 24 and 72 h after surgery in group V (P < 0.01), whereas that was increased at 24 h after surgery in group P and group P (P < 0.01). Compared with group V, serum IL-6 and CRP levels were reduced at 24 h after surgery in groups P and P (P < 0.01 or < 0.05).

Conclusion: In patients undergoing spinal surgery in the prone position, PCV-VG targeting an end-inspiratory zero flow rate lowers the incidence of PPCs and inflammation levels.

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